European Radiology

, Volume 28, Issue 5, pp 1961–1968 | Cite as

Optimisation of sonourethrography: the clamp method

  • Juan de Dios Berná-Mestre
  • Thierry Balmaceda
  • Diego Martínez
  • Jose F. Escudero
  • Gloria Martínez
  • José A. García
  • Manuel Canteras
  • Juan D. Berná-Serna



To describe the clamp method for performing retrograde sonourethrography (RSUG) and contrast-enhanced voiding sonourethrography (CE-VSUG) via the transperineal approach in male adults.

Materials and methods

Prospective study of 113 males (14-86 years) with urethral strictures confirmed by urethrography who received sonourethrography via the clamp method between 2011 and 2015. The characteristic parameters of the quantitative variables were calculated and a comparative analysis of the qualitative variables was conducted using the McNemar test.


RSUG was performed successfully in all the cases (n = 113) and detected 49 cases with anterior urethral strictures; the strictures in the proximal bulbar cone in five of them (10.2%) were not visualised on retrograde urethrography (RUG) (p < 0.05). CE-VSUG was performed successfully in 97 cases and observed posterior urethral strictures in 82; the bladder neck strictures in 6 of them (7.3%) were not observed on voiding cystourethrography (VCUG) (p < 0.05). Retrograde bladder filling was achieved in approximately 6 min.


The clamp method enables RSUG and CE-VSUG to be performed simply, effectively and painlessly by a single operator. It also allows the evaluation of cases with urethromeatal alterations (stricture, hypospadias and meatotomy).

Key Points

The clamp method enables RSUG to be performed simply and painlessly.

The clamp method requires only one operator and allows assessing urethromeatal alterations.

RSUG shows greater capacity for detecting anterior urethral strictures than RUG.

The clamp method achieves retrograde bladder filling in approximately 6 min.

CE-VSUG shows greater capacity for detecting strictures than VCUG.


Clamp method Sonourethrography Ultrasound contrast Urethral stenosis Urethrography 



Retrograde sonourethrography


Contrast-enhanced retrograde sonourethrography


Contrast-enhanced voiding sonourethrography


Retrograde urethrography


Voiding cystourethrography


Field of view




Visual analogue scale


Verbal descriptor scale


Benign prostatic hyperplasia


Standard deviation



The authors state that this work has not received any funding.

Compliance with ethical standards:


The scientific guarantor of this publication is Prof. Juan de Dios Berná Serna (Head of the Radiology Department of Virgen de la Arrixaca University Hospital).

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Prof. Manuel Canteras Jordana (Head of the Statistics Department of Faculty of Medicine, University of Murcia) kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• prospective

• diagnostic study

• performed at one institution

Supplementary material

330_2017_5211_MOESM1_ESM.mp4 (14.6 mb)
ESM 1 CE-VSUG showing prestenotic urethral dilatation during micturition. (MP4 14901 kb)
330_2017_5211_MOESM2_ESM.mp4 (21.8 mb)
ESM 2 CE-RSUG+CE-VSUG during micturition, showing accurately the length of the total stricture (1.8 cm) in the proximal bulbar urethra. (MP4 22300 kb)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Juan de Dios Berná-Mestre
    • 1
  • Thierry Balmaceda
    • 1
  • Diego Martínez
    • 1
  • Jose F. Escudero
    • 2
  • Gloria Martínez
    • 2
  • José A. García
    • 2
  • Manuel Canteras
    • 3
  • Juan D. Berná-Serna
    • 1
  1. 1.Department of RadiologyVirgen de la Arrixaca University HospitalEl PalmarSpain
  2. 2.Department of UrologyVirgen de la Arrixaca University HospitalEl PalmarSpain
  3. 3.Department of StatisticsUniversity of Murcia, Faculty of MedicineMurciaSpain

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